Outsider: Let’s talk about regs baby, let’s talk about pharmacy

New regulations herald cries of woe, but where are the whoops of joy for NHSE’s investment in pharmacy?

It was less than 24 hours after sending my May column to the editor that the changes to the 100-hour regulations were published. What is the opposite of fortuitous? It doesn’t really matter. 

These new regulations give 100-hour pharmacies a route to reduce their core contractual hours from 100 to 72. Pharmacy press and social media lost their collective minds. Cries of woe. 100-hour contractors are obviously evil, and the perception that they have suddenly been given a ‘leg-up’ over existing 40-hour contractors is abhorrent. 

Yet permit me to take a step back, for a moment. 100 hour contracts were introduced in 2005, principally to appease the competition regulators. It was only four years after ASDA finally prevailed in its fight against Resale Price Maintenance – a protectionist practice that had been mostly made illegal in 1964, yet still benefited pharmacy. Now the authorities had their eyes on the closed nature of pharmaceutical lists.

Welcome then, the four horsemen of the apocalypse – or exemptions, as they’re more widely known. The out-of-town large (15,000m2) retail park exemption and the one-stop-shop health centre exemptions only lasted a few years. The 100-hour and distance selling exemptions proved popular. Would-be pharmacy owners – who previously had zero chance of gaining access to the pharmaceutical list – realised that they could not only own their own pharmacy but actually thrive whilst doing so. 

Hear then the cries of woe from existing owners who felt threatened. 100- hour pharmacies would destroy existing businesses. Services would be disrupted, patients would be confused.

The competition authorities seem to have been proved right though. We’re 18 years in since these market reforms and there are still over 11,000 pharmacies, about 10 per cent of which are 100-hour contracts. If the creation of 100-hour contracts didn’t lead to the demise of existing contractors then the easements won’t destroy the network either. What they might do is relieve workforce demand by the equivalent of 800 full-time pharmacists, and everyone should benefit from that.

In other news, NHS England has been on a £645 million shopping spree. What does £645m buy you in community pharmacy, I wonder? Eighteen months ago, it would have been enough to purchase the LloydsPharmacy group and ancillaries with change to spare.

In 2023, it appears to get you some form of we-can’t-call-it-a-’minor’ ailments scheme. If there were cries of woe at the easement of the 100-hour regulations, there should have been equal whoops of joy at this announcement. 

There have, of course, been the usual people asking why has it taken this long, and then more people taking credit for finally winning the argument. But I’m more interested in what the number tells us. £645m over two years. That’s a very specific number. As if someone has actually sat down and used mathematics to work it out. Not a political decision then – politics is all round numbers written on the back of a house of commons napkin.

It also seems to have blindsided Community Pharmacy England (do I really have to keep calling them that?) and the Department of Health and Social Care alike. The prepared press releases were sparse, with no apparent ministerial photo-op in a pharmacy. NHS England’s decision alone then.

And the fact that it was outside of and in advance of national contract negotiations shows that it cannot wait or rely on those processes. Primary care needs support now, and NHSE has no option but to pay for it. It will be interesting to see what footing this new service is placed on, being negotiated outside of the usual cycle.

It will also be fascinating to see what fee structure falls out of this. PSNC (sorry – I can’t do it anymore) certainly seems in a pickle about fees. 

Tied up in the announcement of the £645m was the expansion of the blood pressure testing service and the contraceptive service. The same contraceptive service it is refusing to endorse the fee structure for.

There’s plenty to disagree about on most of the current fees, so it seems odd to be belligerent about the £18 contraceptive service fee when pharmacies are happily selling them OTC for under a £5 margin. 

Perhaps this is the time the wind changes though? It certainly feels as though we may be in a seller’s market for pharmacy for once. How then will the need for expediency (on both parties) be balanced with prudence, particularly in light of the contraceptive service?

One more thing about that number... £322.5m a year is also a good approximation of the money contractors lost with the withdrawal of establishment payments, adjusted for inflation. I’m sure that’s just a coincidence.

Outsider is a community pharmacist